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IFOR CITY <br />Received by: '~ - -..j '~l <br />Date: <br /> <br /> ELECTRICAL I RMIT APPLICATION <br /> Please complet~all ~ec(~°~s, I through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br /> Office: Phone 588-5147 8:00am - 4:30pm <br /> FAX: 588-7948 <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK 1S NOT [ <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> I <br /> WORK IS SUSPE~IDED FOR 180 DAYS. <br /> <br />P.A. CONTRACTOR INgTALLATION ONLY <br /> <br />Electrical Contractor <br /> <br />Phoneg Fax# <br /> <br />Contractor's Board Reg No. ~} / Job No. <br /> <br />Signature of Supervising Electrician <br />Supervisor's License No. 2. q 2"7 $'~, I Pm~ee~e'ttT-~ 76/7 <br />:a. FOR OW mR mST L, xouS <br /> <br />Prop~Ry Owner (please print) <br /> <br />Mailing AddLes : [ Phone <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. <br /> <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />PERMIT NO: <br />Date: <br /> <br />Issued by: <br /> <br />4. FI~E SCHEDUL~ (Complete and enter total in Al beIow) <br />A. Rosidential P~ Unit Number of Inspections per permit allowed -~ <br /> S~'vi~ Included: Items Cost (each) $ <br /> ,,mi <br />1000 sq. ft. or les~ ~r $85.00 4 <br />Each additional 50Os4; ft. <br /> or pertiq~ thereof $15.00 __ <br />Limited Energy ~ $20.00 <br />Each Manufactured l~ome or Modular <br /> Dwellin~ ,Service or Feeder $40.00 2 <br /> <br />B. Services or Fe~rden (Does not include branch circuits, see section D) <br /> <br />Installation, AIt~ation or R~loeation <br />200 amps or less ~ <br />201 amps to 400 amps <br /> <br />$60.00 -- 2 <br />$100.OO __2 <br />$130.00 -- 2 <br />$300.00 -- 2 <br />$40.00 __ 2 <br /> <br />$35.00 2 <br />$40.00 2 <br />$80.OO 2 <br /> <br />$ 2.00 <br /> <br />$35.00 <br />$2.00 <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$5O.OO <br /> <br /> sq. fi. x $.068 =__ <br /># of Labels <br /> <br />5. FEES Al. Enter total of fees from Se~. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if required <br /> C. Investigation Fee (if required) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. -- <br /> <br />$. <br />$. <br />$. <br /> <br />MC 15-341/96 <br /> <br /> <br />